Hospital first aid effect on patients with traffic accident severe craniocerebral injury: a report of 1107 cases / 中华神经医学杂志

Objective To make reference for relevant departments of our country to develop acute craniocerebral trauma prevention and control measures based on the general rule of hospital first aid by changing the links as signs of life, consciousness, pupil and time for hospital emergency in patients with traffic accident severe traumatic brain injury. Methods The clinical data of 1107 patients with severe traumatic brain injury,collected from April 1,2008 to March 30,2009,were analyzed; these patients were chosen according to the severe traumatic brain injury statistical table made by Department of Neurosurgery of Zhujiang Hospital and authorized by committee of experts from 71 other hospitals.The consciousness,pupil changes,GCS scores,blood pressure, respiration,pulse index changes on admission and at time out of emergency department were analyzed and compared; according to these results,function projections was performed; development tendency of the disease and rescue effect were judged, and the next treatment measure step was determined. Results According to the hospital emergency time,most patients got to the Emergency at 10-60 min after the injury,mostly at 10-30 min after the injury (38.9％).The consciousness,pupil changes,GCS scores,blood pressure,respiration,pulse index changes of most patients gradually developed to good trends after hospital first aid; before the patients received further specific treatment, the vital signs and indicators of them were gradually stabilized. Function projections supported these results. Conclusion Hospital first aid and effective treatment,timely controlling indicators,correct diagnosis and all reasonable measures improving hospital first aid can help to improve the first aid quality of patients with traffic accident severe traumatic brain injury.

Virtual endoscopy in endoscopic pituitary tumor resection through the endonasal transsphenoidal approach / 中华神经医学杂志

Objective To observe the anatomical structure via endonasal transsphenoidal approach with virtual endoscopy (VE) and explore the clinical applications of VE in endoscopic pituitary tumor resection through the endonasal transsphenoidal approach. Methods The VE was applied to the reconstruction of the pre-surgical 64-slice CT scanning of the 21 patients with pituitary adenoma received the endoscopic endonasal transsphenoidal surgery. A comparative study and a correlation analysis of cumulative scores of the anatomical structure were performed between the reconstructed VE images and the intraoperative endoscopic ones. Results Preoperative VE images and intraoperative endoscope images are very similar. The correlation of cumulative scores of the anatomical structure between the VE images of anatomical findings and the intraoperative images was positively noted (r=0.923, P=0.001),indicating that VE can be applied to simulately observe the anatomical structure before the endoscopic endonasal transsphenoidal pituitary surgery, and observe the anatomical structure through the endonasal transsphenoidal approach. Conclusion Being able to display the important anatomical structure and its varieties before the endoscopic endonasal transsphenoidal pituitary surgery, VE proves to be a valuable approach to the preoperative planning, increases the surgical efficiency and improves the safety of the surgery.

Double-blind, placebo-controlled, randomized, multicenter studies of oxiracetam in the treatment of brain injury / 中华神经医学杂志

Objective To evaluate the efficacy and safety of oxiracetam in the treatment of neurological deficits resulting from brain injury through the comparison of oxiracetam for injection and piracetam for injection in clinical trials. Methods A multiple-center, randomized, double-blind,parallel study was performed on 239 patients; these patients were divided into experimental group (oxiracetam for injection, n=120) and control group (piracetam, n=119). National institutes of health stroke scale (NIHSS), Glasgow coma scale (GCS), myodynamia grading, mini-metal state examination (MMSE) were employed to evaluate the therapeutic effects; electrocardiogram and laboratory examination were performed, and the side effects were also observed. Results The scores of NIHSS,GCS and myodynamia grading after treatment in the 2 groups were all significantly higher than those before treatment (P＜0.05); however, no significant differences on these scores were noted between the experimental group and control group (P＞0.05). No serious adverse events were noted in both groups.Conclusion Oxiracetam, the same as piracetam, is safe and effective in the treatment of neurological deficits secondary to brain injury.

Pre-hospital emergency treatment and prognosis analysis of patients with severe brain injury accidents: a report of 1107 cases / 中华神经医学杂志

Objective To analyze the importance of pre-hospital emergency treatment in patients with severe head injury in traffic accidents in terms of time and explore the general rule of severe head injury in traffic accidents to provide some evidence for relevant authority making the prevention and control measures of acute traumatic brain injury. Methods The patients were selected according to "statistical table of severe head injury in a traffic accident" established by our department; their correlated data were statistically analyzed. Based on the time intervals between receiving telephone time asking for first-aid and arriving to location of incidence, and time intervals between time of giving first-aid and injured time, the regularity of prognosis was analyzed.Results With the prolonged time intervals between time of giving first-aid and injured time, the mortality and disability rates gradually increased,followed by poor prognosis, which indicated that the prognosis was negatively correlated to the delayed time on the way and the on-site rescue time (rs=-0.10,P=0.002; rs=-0.06,P=0.034). Conclusion Prevention and control center for acute brain injury should be built and the roles for pre-hospital emergency treatment and transportation should be established to decrease the injured time (the delayed time on the way and the on-site rescue time) to improve the quality of care, and to reduce the death and disability in patients with severe head injury in traffic accidents.

Effects of teniposide combined with semustine on O6-methylguanine-DNA methyltransferase expression in patients with glioma / 中华神经医学杂志

Objective To study the relationship between O6-methylguanine-DNA-methyltransferase(MGMT)expression in gliomas and the efficacy of teniposide(VM-26)combined with somustine(Me-CCNU). Methods A retrospective chart review was performed on 47 patients diagnosed by pathology as having gliomas.The expression of MGMT in all paraffin sections of the patients were determined by immunohistochemical technique.The clinical efficacy was observed and the overall survival rates were analyzed. Results The positive rate of MGMT in all the 47 patients was 40.4%.Three-year survival rate of the negative group was 66.7%and that of the positive group was 52.6%without statistical significance(P>0.05).The average OS of the negative group was 67.861±10.094 and that of the positive group was 47.263±7.983 without statistical significance(P>0.05).Bone marrow suppression of grade I was found in 11 patients with 6 appearing stomach discomfort,vomiting,diarrhea,loss of appetite and digestive symptoms.Conclusions MGMT is one agent of drug resistance of nitrosourea.VM-26 combined with Me-CCNU chemotherapy can overcome the resistance effect of MGMT with little side effects.

Correlation between magnetic resonance imaging manifestations and prognosis in long-term consciousness disorder patients with severe traumatic brain injury / 中华神经医学杂志

Objective To explore the correlation between magnetic resonance imaging(MRI)manifestations and the prognosis in long-term consciousness disorder patients with severe traumatic brain injury(TBI).Methods MRI data were collected in 66 patients with a duration of disturbance of unconsciousness for more than 2 weeks.These patients suffered from severe TBI and were admitted to our hospital from January 2003 to August 2008.The data about regions of abnormal signal in T2WI in the brain stem,the thalamus,the basal forebrain,the corpus callosum,the cerebral cortex and the subcortical area were recorded and analyzed.The patients were divided into conscious and unconscious groups based on the outcome 6 months after the injury.Logistic regression analysis was used to calculate the OR value between the lesions and the poor outcome of the patients.Results The lesions of the dorsal upper brain stein,the thalamus and the corpus callosum between the conscious and unconscious groups were significantly different.The lesions of the dorsal upper brain stem,the corpus callosum and the thalamic by MRI predict the poor outcomes.Conclusion The MRI manifestations can demonstrate the cerebral dysfunction and probabilities of patients' outcome objectively and accurately.

Neuroendoscope-assisted micro-invasive surgical treatment of hypertensive thalamic hemorrhage / 中华神经医学杂志

Objective To develop a minimally invasive operating technique for the treatment of hypertensive thalamic hemorrhage. Methods The clinical data of 15 patients with hypertensive thalamic hemorrhage performed neuroendoscope-assisted micro-invasive surgical treatment in our hospitals from July 2007 to June 2010 were retrospectively analyzed; their treatment efficacy were also concluded. Results The mean operation time of these patients was (1.5±0.4) h and the amount of blood loss was 30-40 mL; the mean clearance rate of hematoma in the thalamus was (86.2 ±7.9)percentage. Patients were followed up and evaluated by Glasgow outcome scale for at least 3 months.Three patients (21.4%) showed good recovery, 4 (28.6%) moderate disability, 4(28.6%) severe disability and 2 (14.3%) vegetative survival; 1 patient (7.1%) died. Conclusion Neuroendoscope-assisted micro-invasive surgical treatment is a fast and minimally invasive operating technique with little blood loss in the treatment of hypertensive thalamic hemorrhage.

Benign fibrous histiocytoma involving the skull: a case report and literature review / 南方医科大学学报

Benign fibrous histiocytomas (BFH) represent a rare group of tumors with a common origin from the tissue histiocytes, often causing pain and space-occupying effect. BFH of bone causes diagnostic difficulties due to its atypical clinical symptoms, radiographic features and cytological characteristics, which can be easily confused with other benign lesions such as non-ossifying fibroma (NOF), giant cell tumor (GCT), and fibrous dysplasia. The lesions are prone to relapse, and the patients often show poor response to radiotherapy and chemotherapy, therefore radical lesion resection should be the therapeutic target of this disease. This paper reported a case of BFH involving the skull and reviewed the associated literatures.

Analysis of prognosis factors of craniocerebral traffic injuries / 中华神经医学杂志

Objective To explore the clinical factors affecting the prognosis of craniocerebral traffic injuries to provide scientific evidence for ameliorating the prognosis. Methods We retrospectively analyzed the clinical data of 652 patients treated in our hospital for serious injuries in car accidents (Glascow Coma score [GCS] 3～8) between February, 1998 and February, 2008. According to the Glasgow Outcome Scale (GOS) three months after injury, patients were divided into good prognosis and poor prognosis groups. Their gender, age, type of brain injury, admission time, pupil status, blood oxygen saturation, systolic blood pressure, level of blood sugar, Injury Severity Score (ISS) and GCS were compared. Results As compared with the good prognosis group, the poor prognosis group showed a significant low level of blood oxygen saturation and systolic blood pressure, low GCS and pupils status score (P<0.05);it showed a long admission time, a significant high level of blood sugar and high ISS (P<0.05). Bad prognosis appeared in intracranial hematoma, contusion and laceration of the brain. And the level of blood sugar and oxygen, GCS and ISS were the independent factors affected the prognosis. Conclusion The level of oxygen saturation and blood sugar, ISS and GCS can help to evaluate the prognosis of patients with severe brain injury, effectively.

Neuroprotective effects of angiotensin Ⅱ type 1 receptor blocker on intracerebral hemorrhage in spontaneously hypertensive rats / 中华神经医学杂志

Objective To investigate the neuroprotective effects of angiotensin Ⅱ type 1 receptor (AT1R) blocker olmesartan medoxomil (OLM) on intracerebral hemorrhage (ICH) in spontaneously hypertensive rats (SHRs). Methods SHRs (male, 12 weeks old; weighing 300±20 g) were randomly assigned to normal, ICH, vehicle-treatment ICH (control), OLM-treatment ICH (OLM) groups. ICH was induced via stereotaxic right basal ganglia administration of collagenase type Ⅶ. One hour after ICH, the rats in OLM group were given a single oral dose of OLM (10 or 3 mg/kg solved in 1 mL sodium carboxymethylcellulose) via nasogastric feeding, and those in the control group received an equal volume of sodium carboxymethylcellulose only. Six hours after ICH induction, mean arterial blood pressure (MAP) was measured using the non-invasive method of tail-cuff plethysmography in conscious rats. Twenty-four hours after ICH induction, neurobehavior was detected by the modified limb placing test (MLPT); brain water content was measured by dry-wet method; the mRNA expression levels of receptor and target genes were analyzed by real-time PCR. Results MAP in the ICH group ([121.4±3.5] mm Hg) did not significantly differ from baseline pressure in the normal group ([120.2±3.8] mm Hg)(P>0.05); MAP in the OLM group with 10 mg/kg ([105.6±3.1] mm Hg) was significantly lower than that in the ICH group (P<0.05); the OLM group with 3 mg/kg ([120.8±3.1] mm Hg) and control group ([118.6±3.9] mm Hg) did not induce blood pressure reduction, and did not show significant difference as compared with the ICH group (P>0.05). In the hemorrhagic hemisphere, brain water content in the OLM group with 3 mg/kg (80.02%±0.32%) had significant difference from that in the ICH group (80.90%±0.36%, P< 0.05); brain water content of the control group (80.81%±0.32%) was slightly lower than that of the ICH group, without significant differences (P>0.05). The OLM group with 3 mg/kg (5.03±0.71) was showed significantly lower score of MLPT as compared with that in the ICH group (6.62±0.55, P<0.05). The score of MLPT in the control group (6.41 ±0.55) did not differ from that in the ICH group (P>0.05). In the hemorrhagic hemisphere, the mRNA expressions of AT1R and target genes, such as HO-1, COX-2, IL-6 and VCAM-1, in the OLM group with 3 mg/kg were significantly lower than those in the ICH group (P<0.05), but the difference between the control and ICH groups did not show statistical significance (P>0.05). Conclusion Treatment with low doses of OLM in the experimental ICH of SHRs may promote its neurological recovery and induce its neuroprotective effects, including reduction of edema, inhibition of inflammation and oxidative stress.